scholarly journals Point-of-Care Ultrasound by Nonexpert Operators Demonstrates High Sensitivity and Specificity in Detecting Gallstones: Data from the Samoa Typhoid Fever Control Program

2022 ◽  
Author(s):  
Seth Hoffman ◽  
Sachin Desai ◽  
Michael Sikorski ◽  
Glenn Fatupaito ◽  
Siaosi Tupua ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Point Of Care ◽  
Control Program ◽  
High Sensitivity ◽  
Point Of Care Ultrasound ◽  
Food Handlers ◽  
Household Contacts ◽  
Swat Team ◽  
Pilot Feasibility Study ◽  
Stool Cultures

Approximately 90% of chronic typhoid carriers with persistent Salmonella enterica serovar Typhi (S. Typhi) gallbladder infection have gallstones. In Samoa, where typhoid fever has been endemic for many decades, risk factors predisposing to the development of gallstones are increasing among adults. The Samoa Typhoid Fever Control Program dispatches a “Typhoid Epidemiologic SWAT Team” to perform a household investigation of every blood culture-confirmed case of acute typhoid fever. Investigations include screening household contacts to detect chronic carriers. Following limited training, two nonexpert ultrasound operators performed point-of-care ultrasound (POCUS) on 120 Samoan adults from August to September 2019 to explore the feasibility of POCUS to detect individuals with gallstones during household investigations and community screenings. POCUS scans from 120 Samoan adults in three cohorts (28 food handlers, two typhoid cases and their 18 household contacts, and 72 attendees at an ambulatory clinic) were reviewed by a board-certified radiologist who deemed 96/120 scans (80%) to be interpretable. Compared with the radiologist (gold standard), the nonexpert operators successfully detected 6/7 Samoans with gallstones (85.7% sensitivity) and correctly identified 85/89 without gallstones (95.5% specificity). The proportion (24/120) of uninterpretable scans from this pilot that used minimally trained clinicians (who are neither radiologists nor ultrasound technicians) indicates the need for additional training of POCUS operators. Nevertheless, this pilot feasibility study engenders optimism that in the Samoan setting nonexperts can be trained to use POCUS to diagnose cholelithiasis, thereby helping (along with stool cultures and Vi serology) to identify possible chronic S. Typhi carriers.

scholarly journals The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
A. Pourmand ◽  
U. Dimbil ◽  
A. Drake ◽  
H. Shokoohi
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Imaging Modality ◽  
Point Of Care ◽  
High Sensitivity ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Short Term ◽  
Intestinal Peristalsis

Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO.

scholarly journals Pericarditis masking a localised thoracic aorta dissection: Making a point for point-of-care ultrasound

2020 ◽  
pp. 201010582097866
Author(s):  
Raja Ezman Raja Shariff ◽  
Ahmad Farook ◽  
Chiao Wen Lim ◽  
Sazzli Kasim
Keyword(s):  
Chest Pain ◽  
Aortic Root ◽  
Point Of Care ◽  
Acute Chest Pain ◽  
High Sensitivity ◽  
Sudden Onset ◽  
Initial Assessment ◽  
Point Of Care Ultrasound ◽  
Persistent Symptoms ◽  
Start Up

Early detection of aortic dissection (AD) remains essential due to high mortality rates. We report a case of localised thoracic AD initially misdiagnosed as pericarditis, but subsequently diagnosed through point-of-care ultrasound (POCUS). A 35-year-old gentleman presented with sudden-onset jaw and chest pain. An initial electrocardiogram revealed changes consistent with pericarditis, and high-sensitive troponin levels on admission were not raised. An initial diagnosis of pericarditis was made. However, due to persistent symptoms despite treatment, an urgent POCUS was performed, revealing a prominently dilated aortic root, with evidence of an intimal flap near the coronary cusps. Computed tomography imaging revealed a focal aortic root dissection confined within the sinus of Valsalva, with no involvement of coronary arteries or descending thoracic or abdominal aorta. This case highlights how commonly a misdiagnosis of AD can occur and how concurrent pericarditis can often mask AD. Our report highlights the need for better incorporation of POCUS in the initial assessment of acute chest pain, as studies have shown both high sensitivity and specificity in diagnosing AD, with no additional burden on treatment start-up time and mortality.

scholarly journals Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Bjarte Sorensen ◽  
Steinar Hunskaar
Keyword(s):  
Systematic Review ◽  
Emergency Medicine ◽  
General Practitioners ◽  
Clinical Studies ◽  
Point Of Care ◽  
High Sensitivity ◽  
High Specificity ◽  
Point Of Care Ultrasound ◽  
Organ Systems ◽  
Wide Range

Abstract Background Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services. Methods Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. Results On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. Conclusion Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients.

scholarly journals Diagnostic accuracy of bedside ultrasonography in COVID-19 suspected patients admitted to the emergency department

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Radiation Exposure ◽  
Predictive Value ◽  
Point Of Care ◽  
Lower Lobe ◽  
High Sensitivity ◽  
Point Of Care Ultrasound ◽  
Sensitivity Rate ◽  
Low Sensitivity ◽  
The Right

Introduction: Due to the risk of cross contamination and radiation exposure of computed tomography (CT) and low sensitivity rate of X-Ray, point of care ultrasound (POCUS) lung can be used as a diagnostic tool of COVID-19 pneumonia. The current study aimed to evaluate the potential of POCUS for detection of lung pathologies caused by COVID-19. Methods: This prospective observational study was conducted with 84 patients admitted to the emergency department with suspected COVID-19. CT and POCUS lung were performed for all participants. CCT was taken as the reference diagnostic method and the presence of B-lines or consolidation or pleural irregularity-thickening (>3 mm) in the lung in POCUS lung, were evaluated in favor of COVID-19 pneumonia. Results: Of the 84 patients included, lesions of COVID-19 pneumonia were detected 53.5%. COVID-19 pneumonia findings were shown by POCUS lung in 51.2% of participants. The left lower lobe in 48.8% and the right lower lobe in 47.6% of the patients were the most commonly affected regions. In POCUS lung, COVID-19 pneumonia lesions located in 2nd area for 44.0%, in 7th area for 35.7%, in 8th area for 34.5%. Sensitivity of POCUS lung was found to be 88.9%, specificity pointed for 92.3%, positive predictive value was 93.0% and negative predictive value was 87.8%. Conclusion: POCUS lung, has a high sensitivity and specificity in the diagnosis of COVID-19 pneumonia, especially in severe lung involvement. Therefore, POCUS lung should be the method of choice as its practical use, bedside availability and avoidance of radiation exposure for COVID-19 associated lung lesions.

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

POCUS Journal ◽  
2017 ◽  
Vol 2 (2) ◽  
pp. 15-17
Author(s):  
Rimi Sambi, MD ◽  
Heather Sawula, MD ◽  
Brent Wolfrom, MD ◽  
Joseph Newbigging, MD
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Point Of Care ◽  
Training Session ◽  
Undergraduate Curriculum ◽  
Knowledge Retention ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Medical Undergraduate ◽  
Fast Exam

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing [1]. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University. Third year medical students (n=18) were recruited to participate in a training session involving a 1-hour online video and 2-hour hands-on session. Knowledge based surveys were completed before and after the training. A survey was completed 4 months after the teaching session evaluating knowledge retention, comfort, and application of skills. Student knowledge of PoCUS and FAST increased and was maintained (pre-training 56%±20%, post-training 82%±10%, p<0.001). Self-evaluation of comfort performing a FAST examination (5-point Likert scale) similarly increased post-training session (pre-training 1.4±0.8, post-training 3.8±0.9, p<0.005), but decreased 4 months later (3±1.2, p<0.005). Students in this study were unanimously interested in ultrasound training and the methods used effectively increased theoretical knowledge and comfort with use. Students did not retain their comfort levels with FAST exam 4 months after the training session, nor did they have the opportunity to utilize the skills learned. Further evidence is required to identify the applicability of these results to undergraduate curriculum development.

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